A Matter of Life and Death: Act I

July 15, 1854

Today was a day much like many others, but as always, it will linger in my mind. I was called to a home in the neighborhood of Soho, a falling down single room consisting of little more than a palette for sleeping, a table for eating, and a “privy pail” in the corner. Though many of the richer neighborhoods begin to have indoor plumbing to remove human waste, such luxuries have not yet made it to Soho. Indeed, it is not uncommon for those who live in such neighborhoods to simply empty the privy pails through their floorboards into the cesspits below their homes.

Today’s patient was Mary, a young laundress, only just married. Whilst completing her daily washing at the Broad Street water pump, she felt a stomach complaint that quickly led to casting up of her accounts. Though she drank water from the pump, her thirst could not be satisfied, and she was soon beset by terrible leg cramps—a sign of dehydration, or lack of water in the body. Her husband, John, stood silent in the corner during my examination as I felt her pulse weaken. He knew the cause as well as I did, though his eyes pleaded with me to give him any other explanation.

I could not.

Cholera. A death sentence.

Indeed, her spirit moved on before nightfall. They had only been married 10 days.

    The pamphlet I authored some five years ago— “Mode of Communication of Cholera” has resurfaced, likely as a result of my newfound fame after providing anesthesia to her Majesty, Queen Victoria, during the birth of her eighth child, Prince Leopold. When this pamphlet was first published, out of monies from my own pocket, it was ridiculed for my firm belief that cholera is somehow passed from person-to-person. Most medical practitioners continue to believe it caused by an excess of yellow bile in the blood. They think it spreads through miasma—foul smelling air.

Many of these medical men, of course, have never known true poverty. They hold their noses if they should happen to pass by the Broad Street water pump, or cover their faces in perfume-scented cloths. I, however, grew up in a neighborhood similar to Soho in northern York, watching as the sludge of the River Ouse flooded our streets, bringing with it waste from sewage, cemeteries, and market squares. I saw firsthand how each of these floods also brought an increase in illness. During my various medical apprenticeships, I also saw how even out in the country, cholera can spread from person to person living in the same household, regardless of the cleanliness of the air.

As I walked back to my own home after confirming the worst of poor John’s fears for his dear Mary, I listened to horse-drawn carts clatter over cobblestones, kicking up the stink of refuse and sewage that lines the gutters. Ragged children ran through the fog of coal smoke that never seems to clear from the sky. London is a city full of noise and smells, life and decay, all tangled together. The very air seems to cling to you, thick with soot and the ever-present stench of new factories.

As I recall how the life drained from Mary’s wan face, the light dimming from her sunken eyes, her husband realizing the future they had planned would never be…I realized: I must do something. It is not enough to simply stand by and leave helpless people to their fates—not if this wretched disease can be stopped. And stop it, I shall. But how?